BIGHORN PPO HEALTH INSURANCE POLICY

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1 BIGHORN PPO HEALTH INSURANCE POLICY This document provides a brief overview of the benefits offered under the Colorado HealthOP Bighorn PPO Health Insurance Policy. Full information is available in the Certificate of Coverage. To request a copy of the Certificate of Coverage, call P1

2 BIGHORN PPO HEALTH INSURANCE POLICY BIGHORN PPO PLAN AT A GLANCE The Colorado HealthOP Bighorn Preferred Provider Organization (PPO) Plan is one of our gold-level health insurance plans. Some key features of this plan include: YOUR CHOICE OF HEALTHCARE PROVIDERS: You can visit any healthcare provider you d like, but you may pay less if you use doctors, hospitals and other healthcare providers in Colorado HealthOP s network. You can also save money by using a Tier 1 primary care doctor, who is recognized by one or more organizations that measure clinical quality achievements. FREE PRIMARY CARE OFFICE VISITS: In addition to a free wellness visit, your next two primary care office visits to treat an illness or injury are no cost to you. NO COST FOR GENERIC PRESCRIPTIONS: Our Bighorn plans now cover all generic prescription drugs at no cost to you. REWARDS FOR TAKING HEALTHY STEPS: When you complete three health actions, you ll get rewarded with: Lower-cost or free primary care office visits for the rest of the year Lower out-of-pocket costs for specialist visits Free in-network behavioral health office visits A $150 debit card to be used for qualified medical expenses A lower out-of-pocket maximum Coverage for acupuncture and chiropractic services READ MORE ABOUT HOW TO GET REWARDED FOR TAKING HEALTH ACTIONS ON PAGE 4. WHY COLORADO HEALTHOP? Colorado HealthOP is a nonprofit health insurance cooperative (CO-OP) that s focused on people, not profits. Here s what sets us apart: More Control Over Your Healthcare We re a CO-OP, which means you have a voice in how your health insurance company is run. Our members sit on the board of directors and weigh in on what s covered under our benefit plans. At Colorado HealthOP, all of our members are working together to take care of their own health and reduce the cost of healthcare for everyone. A Focus on Preventive Care, Not Sick Care We think health insurance should help you stay healthy, not just take care of you when you re sick. Our benefits are designed to help you and your family catch healthcare issues early before they become major, expensive health problems. A No Surprises Philosophy We know health insurance is complicated, and we re committed to helping you understand your benefits. If we can serve you better, we want you to let us know, so we can improve our service for all of our members. P2

3 P3 BIGHORN PPO PLAN OVERVIEW GOLD BIGHORN PPO Health Insurance Policy (Cofinity Network) Standard Enhanced Out-of-Network Maximum Lifetime In-Network Benefits No Lifetime Maximum Annual Deductible (Embedded) Standard Enhanced Out-of-Network Individual $1,000 $2,000 Family $2,000 $4,000 Annual Out-of-Pocket Maximum Standard Enhanced Out-of-Network Individual (Includes Deductible) Health Actions: $3,750 (1) Health Survey $3,250 Family (Includes Deductible) (2) Biometric Screening No Maximum $7,500 (3) Wellness Visit $6,500 Health Incentive Account Standard Enhanced Out-of-Network Debit Card for Medical Expenses Not Applicable $150 Not Applicable Office Visits Standard Enhanced Out-of-Network Annual Wellness Visit 100% Covered Additional Primary Care Office Visits to Treat an Injury or Illness Two (2) 100% Covered Primary Care Visits in Addition to Your Wellness Visit (Exc. Well Baby, Preventive, and X-rays) Additional Tier 2 Primary Care Office Visits $30 $15 Additional Tier 1 Primary Care Office Visits 1 $20 Behavioral Health $60 100% Covered Specialist $60 $40 Acupuncturist or Chiropractor No Coverage $40 3 No Coverage Professional Services Standard Enhanced Out-of-Network Lab & X-Ray Deductible + 35% Coinsurance Hospital & Facility Services Standard Enhanced Out-of-Network Hospital Facility Hospital Physician Deductible + 35% Coinsurance Emergency Room Services $350 Copay Emergency Transportation Deductible + 35% Coinsurance Urgent Care Center $150 Prescription Drugs 2 (Not Subject to Deductible) Pediatric Dental (Embedded) Standard Enhanced Out-of-Network Retail Generics: 100% Covered Preferred Brand: $30 Other: 35% Coinsurance Mail Order Generics: 100% Covered Preferred Brand: $60 Other: 35% Coinsurance Included (Delta Dental PPO Network) Retail and Mail Order Generics: No Coverage Preferred Brand: No Coverage Other: No Coverage 1 Tier 1 providers share our commitment to improving quality and reducing costs. Visit to find a Tier 1 provider. 2 In an effort to offer cost-effective benefits, we have an additional prescription drug discount card. It is not insurance and doesn t coordinate with benefits. Visit our website to learn more about the CO-OP Discount Pharmacy Program. 3 This does not apply to your out-of-pocket maximum.

4 LOWER YOUR HEALTHCARE COSTS IN THREE STEPS As a Colorado HealthOP member, you will be upgraded from the standard version of your plan to the enhanced version when you complete three health actions. HOW TO COMPLETE YOUR HEALTH ACTIONS STEP 1: TAKE A HEALTH SURVEY Take a quick, confidential online health survey. It will give you and your primary care doctor a snapshot of your current health and risk for health issues. STEP 2: GET A BIOMETRIC SCREENING Schedule a visit at your primary care doctor s office, and get a biometric screening. This free and confidential test will screen for illnesses and identify your risk for certain health conditions. STEP 3: HAVE A WELLNESS VISIT WITH YOUR PRIMARY CARE PROVIDER Go to your primary care doctor for an annual wellness visit. The visit is free and it s your chance to discuss your health survey, biometric screening and other health concerns with your doctor. GET REWARDED! When you complete all three health actions, you ll be rewarded with: Lower-cost or free primary care office visits for the rest of the year Lower out-of-pocket costs for specialist visits Free in-network behavioral health office visits A $150 debit card to be used for qualified medical expenses A lower out-of-pocket maximum Coverage for acupuncture and chiropractic services SEE PAGE 3 TO LEARN MORE. SHOULD MY SPOUSE AND/OR KIDS COMPLETE THE HEALTH ACTIONS? If you have a spouse and/or children who are covered by your plan, the entire family will be upgraded to the enhanced plan when you and your spouse complete the health actions. If you choose a child-only plan, your child(ren) will be upgraded to the enhanced plan when they complete a wellness visit. P4

5 HOW TO GET STARTED You can purchase the Colorado HealthOP Bighorn PPO plan on Connect for Health Colorado, or on Colorado HealthOP s website: On Colorado HealthOP s website, you can: Compare your plan options Get a quote Sign up for your health insurance plan, plus your family s TAX CREDITS To receive a tax credit, you must purchase your plan through Connect for Health Colorado or through a licensed health insurance broker. To learn more, call us at HAVE QUESTIONS? CONTACT US! CALL: Our knowledgeable staff can help you figure out the right plan for you and sign you up over the phone. VISIT: WRITE: 8000 E. Maplewood Ave. Building 5, Suite 200 Greenwood Village, CO P5

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